Deep dive into chronic fatigue syndrome from a Chinese medicine perspective with Peter Slipper, one of Melbourne’s best Chinese Medicine practitioners.
What is Chronic Fatigue Syndrome?
Chronic Fatigue Syndrome (CFS) is also known as Myalgic Encephalomyelitis (ME). It is a complex and debilitating condition characterised by extreme fatigue that doesn’t improve with rest. This fatigue affects daily functioning and can be accompanied by a range of symptoms that can include:
- Cognitive/memory difficulties – brain fog
- Sleep disturbances and unrefreshed sleep – tired but wired
- Muscle and/or joint aches and pains
- Recurrent sore throats/swollen glands
- Recurring headaches
- Dizziness
- Digestive complaints
- Menstrual irregularities
- Body temperature regulation issues
The list could go on. Western medicine is still unclear on the exact cause of CFS, although it is thought that it involves a combination of factors that include viral infections (including the recent addition of “Long Covid”), immune system abnormalities and stress. This combination of symptoms and causative factors aligns with a pattern in classical Chinese medicine known as Shao Yang Syndrome.
What is Shao Yang Syndrome?
Shao Yang syndrome is an energetic pattern in a theoretical framework known as 6 Phase Theory. Chinese Medicine uses theoretical frameworks to understand how the body works, and what happens when it doesn’t. We use 6 Phase Theory to understand how our immune system reacts to pathogens such as viruses, bacteria and other parasites, from the very first sign of infection to resolution. It also allows us to identify what happens when complications arise if someone is unable to adequately fight off an infection.
Shao Yang is the phase where the immune system has been weakened by an infection to the point where it can no longer recover effectively. This weakness has a knock-on affect to other systems in the body and results in systemic inflammation on top of an underlying deficiency/fatigue. By this stage, it is no longer the actual pathogen that is important (be it Ebstein-Barr Virus, Influenza viruses, Covid/SARS, Ross River Virus etc), but rather the dysregulation of normal bodily function that has occurred. In TCM, this is known as a mixed excess/deficiency pattern.
There are a number of symptoms that indicate Shao Yang pathology is present including:
- Cognitive/memory difficulties – brain fog
- Sleep disturbances and unrefreshed sleep – tired but wired
- Muscle and/or joint aches and pains
- Recurrent sore throats/swollen glands
- Recurring headaches
- Dizziness
- Digestive complaints
- Menstrual irregularities
- Body temperature regulation issues
Symptoms will often comes and go or even migrate to different bodily systems.
Sound familiar?
Interestingly, while Shao Yang syndrome was traditionally considered to be a result of an infection, modern knowledge understands that broader threats to immune function such as stress, diet, medication, and poor diet also play a role.
It is also worth noting that other forms of fatigue, such as adrenal fatigue and Long Covid, can also fall into the pattern of Shao Yang syndrome and therefore be treated with similar approaches. In clinic, a person will often say something like “I’ve never been the same since….”.
Treatment Strategies in Chinese Medicine for Chronic Fatigue
The complicated nature of chronic fatigue, and Shao Yang syndrome, gives rise to a situation where simply taking nourishing herbs and supplements often don’t help and can even make symptoms worse. Thankfully we have effective treatment strategies that allow us to simultaneously address inflammation while supporting weakness in the body to assist in recovery.
Chinese herbal Medicine for Chronic Fatigue
I find the most affective herbal treatment strategy for chronic fatigue is to use classical harmonising formulas. These are herbal formulas that aim to bring balance back to the body when there are a multitude of disharmonies happening simultaneously. They will include herbs such as Bupleurum (Chai Hu) and Scutellaria (Huang Qin), which aim to settle the immune system and calm systemic inflammation plus herbs that help to strengthen the body e.g. ginseng (Ren Shen) and licorice (Gan Cao). Any symptom that is complicating recovery is also addressed; for example, nausea or digestive issues will affect your ability to receive the nourishment you need so herbs like fresh ginger (Sheng Jiang) and pinella (Ban Xia) are often included in order to help improve digestive function.
Acupuncture for Chronic fatigue
Acupuncture works by stimulating specific points on the body to create a systemic response. Treatment strategies for chronic fatigue aim to reduce inflammation, calm the nervous system and relieve accompanying symptoms such as anxiety, insomnia, and digestive complaints. Recent studies show that acupuncture has a positive effect of the symptoms of chronic fatigue, for example ‘Evidence-Based Complementary and Alternative Medicine‘ demonstrated that acupuncture reduced fatigue in chronic fatigue syndrome (CFS) patients, possibly by improving sleep quality, mood, and immune function while this systematic review of 51 randomised control trials concluded that “the effect of acupuncture and moxibustion in the treatment of CFS was significantly higher than that of other treatments.”
Lifestyle tips for chronic fatigue
Know your limits.
It’s so easy to over do it. If you find you are yo-yo-ing between a good day and then a couple of really bad days it is likely you are emptying the tank too much on those good days. The rebound, or ‘payback’ usually comes a day or two later.
Prioritise rest.
Schedule little breaks throughout the day to give yourself time to decompress. It helps to educate those around you when you are available for them and when you are not.
Move gently.
Moving the body helps encourage healthy circulation of both blood and Qi. While it can be hard to get motivated and difficult to know when to stop, creating a routine of daily gentle movement is very beneficial. Practices like tai qi, qi gong, yin yoga, clinical pilates, and walking can help improve your energy without taxing the body.
Keep your blood sugars stable.
This is a cornerstone of good health, especially when it comes to CFS. Ensuring each meal consists of easy to digest protein and complex carbohydrates will help maintain stable blood sugars and avoid the crash that relying on caffeine and sugar result in. For more information about Chinese diet therapy read here.
Stress management
Identifying your stress triggers and putting steps, or boundaries, in place to reduce them will help minimise the amount of time you spend operating from your sympathetic nervous system. The sympathetic nervous system prepares the body for “fight or flight” and uses a huge amount of adrenal energy, or Kidney Qi in Chinese medicine. Operating in this way depletes Kidney Qi and leaves the body feeling fatigued.
Sleep
Feeling tired but wired is a common complaint in CFS. It comes from being unable to switch from that sympathetic (adrenal) response to the parasympathetic (rest) response. Putting in place the above lifestyle tips plus having good sleep hygiene goes a long way to improving sleep quality.
Final thoughts
Chinese Medicine has long had a model that allows us to understand and support Chronic Fatigue Syndrome, with all of its diverse presentations. It does this by not only addressing symptoms, but by seeking and finding the underlying imbalances within the body and correcting them with treatments that include Chinese herbal formulas, acupuncture and lifestyle advise tailored to the individual.
By Peter Slipper TCM Practitioner & Acupuncturist at Quiescence Chinese Medicine
